How do I heal a diastasis recti?
Updated: Jan 20, 2021
I hope everyone is coping well at the moment and have been able to at least enjoy the cold, sunny mornings we've been having.
As I'm not seeing many of my mums in person at the moment, I wanted to dive into the two most common postnatal topics that I get asked about: diastasis recti (DR) and pelvic floor. I'll talk about the former today and the latter next week. They are linked as a DR can cause pelvic floor weakness and pelvic floor weakness can worsen a DR. It can also be accompanied by lower back pain. Below are a few myth-busters and facts about DR:
1. Each of us has connective tissue that runs down the midline from the breastbone (sternum) to the pubic bone. This connective tissue (called linea alba) has to stretch to make room for a growing baby. The abdominal muscles also stretch during this process.
2. At the end of pregnancy, every single woman will have what we call a diastasis recti or abdominal separation. This is completely natural and nothing to be afraid of.
3. In many women, this separation closes by itself after 6-12 weeks post-birth.
4. In some women, the separation doesn't close by itself, and specific exercises are prescribed to help the process along.
5. In some cases, a surgical repair may be necessary. This can happen if the gap is large even after several months (or years) of rehab, if it's accompanied by umbilical hernias, and/or the woman is in a lot of pain.
6. There are three important steps to take when treating a DR: optimal breathing, pelvic floor engagement and activating the deepest layer of abdominal muscles, the transversus. In many cases, the above will solve a DR if done correctly and consistently.
7. Some exercises are more helpful than others when it comes to a DR. This includes exercises with short levers that put less pressure on the midline, exercises that activate the deeper abdominals and exercises that help to compress rather than lengthen the abdominal area. Posterior pelvic tilts, bridges, bird/dog, toe taps in table top and half side plank are some examples.
8. Any exercise that creates too much intra-abdominal pressure before the body is ready is too strong at this point in time. This usually includes but is not limited to full planks, full push-ups, sit-ups, double-leg raises and pull-ups.
9. How do I know if an exercise is too much for my DR? If you get doming/coning along your midline and the tissues feel HARD, then there is too much intra-abdominal pressure and you should ease off. If on the other hand the tissues feel soft (despite doming), then you can continue the exercise as you are not straining and stretching the tissues further.
10. Can I check my DR myself? Yes, you can do a rough check at 6 weeks (there is no point in doing it any sooner than this as the tissues are still very soft): lie on your back with your knees bent, start at the sternum and gently press down on the linea alba as you lift your head off the floor on an exhale. Keep doing this all the way down to the pubic bone. You are checking for width (to gauge how well your rectus muscles are working - you would ideally feel them closing in around your finger/s) as well as depth (to gauge how well your transversus is working - ideally there will be a trampoline feel as you press down). A DR is measured as a width of two fingers or more but you can have a functioning DR even if this is the case. This is where activating your deepest abdominals and lateral breathing come in.
If you can afford it, I highly recommend seeing a women's health physio at 6-8 weeks post-birth who can do a full postnatal check-up and determine whether or not you have a DR. I've mentioned before that locally Jade Rodham at Chiswick Physio and The Mummy MOT at One Body Clinic are both great options. There are also other excellent options further afield/online.
Let me know if you have any questions about the above. I've done several courses on DR and have also my own journey of recovery following enforced DR repair surgery after several failed hernia repairs. Knowledge is power so don't be alarmed if you notice a gap - let's work together to heal it.
My Buggyfit class takes place on Thursdays at 1-2pm via Zoom during the third lockdown. You can book it here. I also continue to offer outdoor Personal Training sessions at the special rate of £40/session in January.
Stay safe & healthy,